Provider Demographics
NPI:1598130916
Name:MAIN LINE ADULT COUNSELING, LLC
Entity Type:Organization
Organization Name:MAIN LINE ADULT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:484-343-6136
Mailing Address - Street 1:252 VINCENT RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1127
Mailing Address - Country:US
Mailing Address - Phone:484-343-6136
Mailing Address - Fax:
Practice Address - Street 1:252 VINCENT RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1127
Practice Address - Country:US
Practice Address - Phone:484-343-6136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0178511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA334933ZS0EOtherMEDICARE